* = Required Information
Drug Test Consent Form
Employeer Name
*
Employee Name
*
Test Date
Social Security Number
Department
Position
Employee Start Date
Supervisor
I,
, freely give my consent for this drug and/or alcohol test. I have been fully informed of the reason for this urine test and I understand that the results will be forwarded to my supervisor. If the test results are positive, I will be given the opportunity to explain the results before any action is taken.
Reason for Test:
Other
Reason for Test:
PRE- EMPLOYMENT OR ACCIDENT
Other
Name
*
Date
*
Submit